Individual
MICHELLE MARGARET PETTENGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, CADC
Contact information
Practice address
221 E STATE ST, CENTERVILLE, IA 52544-1813
(641) 856-6471
(641) 856-2779
Mailing address
221 E STATE ST, CENTERVILLE, IA 52544-1813
(641) 856-6471
(641) 856-2779
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
09066
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09066
CADC
IA
Enumeration date
06/24/2009
Last updated
06/24/2009
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